Content area
Full Text
Abstract This case report describes orthodontic management of a young girl with severe class II malocclusion combined with hyperdivergent mandible. Treatment involved extraction of upper and lower first premolars and use of vertical chin cup. The initial severe crowding was resolved and the vertical dimension was successfully maintained. The improved overall facial esthetics and avoidance of future surgical intervention were satisfactorily accepted by the patient and her parents.
Key Words: Class II malocclusion, hyperdivergent mandible, camouflage treatment.
INTRODUCTION Clinical cases of growing skeletal class II malocclusion are considered challenging in the field of orthodontics. There are multiple reported approaches to manage such cases including maxillary headgear, mandibular functional appliances or a combination.1-5 While some treatment modalities utilize two phases of treatment without extraction, other rely on extraction of permanent teeth with a single phase of treatment in the permanent dentition stage.6-7 Orthognathic surgery always remain an option for treating severe skeletal class II cases in adults with or without extraction of permanent teeth.8 When severe skeletal class II facial pattern is combined with class I dental malocclusion, extraction of permanent teeth and orthognathic surgery has been recommended.9 The effect of extraction treatment on the vertical facial pattern to overcome the extrusive nature of fixed orthodontic therapy has long been questioned in the orthodontic literature.10 This case report demonstrates the role of extraction of four first premolars in maintaining the vertical facial dimension, resolving severe crowding and improving overall facial esthetics in a severe skeletal class II high angle case.
CASE REPORT An 11 year and 6 month old female patient presented in private orthodontic clinic with chief complaint of crowded upper and lower teeth. The clinical records (Fig 1) revealed that the patient had symmetrical face, convex profile and incompetent lips at rest with hyperactive mentalis muscle. Intraoral photographs showed class I dental malocclusion with upper and lower right first molars in crossbite, upper lateral incisors in crossbite, increased overbite (50%) and increased overjet (3-4 mm). The upper and lower arches presented with severe crowding (8 and 7 mm, respectively). While the initial panoramic radiograph (Fig 2) revealed normal findings with full complement of permanent teeth, the initial cephalometric radiograph (Fig 3) showed convex profile with hyperdivergent and retrognathic mandible as confirmed by the...